Consent To Treat And Financial Responsibility Guarantee

Last Updated: Nov – 14 – 2025

YOU UNDERSTAND THAT BY CHECKING THE “AGREE” BOX FOR THIS PATIENT CONSENT ON THE THIRST IV SOCIETY WEBSITE OR ANY RELATED BOOKING PLATFORM, YOU ARE ACCEPTING ALL TERMS OF THIS PATIENT CONSENT AND FINANCIAL RESPONSIBILITY GUARANTEE. YOUR CONTINUED USE OF OUR SERVICES CONSTITUTES YOUR LEGALLY BINDING ELECTRONIC SIGNATURE AND ONGOING AGREEMENT TO THESE TERMS.

THIS PATIENT CONSENT IS IN ADDITION TO ANY TERMS OF SERVICE OR OTHER AGREEMENTS YOU ACCEPT WHEN BOOKING WITH THIRST IV SOCIETY. IF YOU DO NOT AGREE WITH ALL OF THE TERMS SET OUT BELOW, YOU MUST NOT BOOK OR RECEIVE SERVICES FROM THIRST IV SOCIETY.

Patient Consent to Medical Services and Telehealth

Thirst IV Society (“Thirst IV Society”, “we”, “our”, or “us”) operates a wellness and hydration service that allows clients to schedule intravenous (IV) therapy and related wellness services, which may be provided in a clinic, at-home, on-site at events, or through other mobile service arrangements. We also may coordinate with independently practicing, licensed healthcare professionals and medical groups (“Providers”) who furnish medical services and clinical oversight where required by law.

You understand and agree that:

• Thirst IV Society and its affiliated Providers offer IV hydration, vitamin and nutrient therapy, and wellness-related services that may include screening, assessment, triage, and recommendations.
• Some services may require that you be evaluated and cleared by a licensed healthcare provider before receiving treatment.
• Depending on your location and applicable laws, services may be rendered directly by Thirst IV Society’s staff, by an affiliated medical practice, or by independent Providers under agreement with Thirst IV Society.

By booking or receiving services, you voluntarily request and freely consent to evaluations, treatments, procedures, and related wellness services that are recommended by Thirst IV Society or its affiliated Providers. You may withdraw your consent at any time by choosing not to continue with treatment or by discontinuing the use of Thirst IV Society services. You understand that withdrawing consent may mean that services are not initiated or may need to be discontinued.

You further understand that, in some jurisdictions, Thirst IV Society acts as a coordination and support service, while clinical decisions and medical services are the sole responsibility of licensed Providers. Those Providers maintain independent professional judgment and are solely responsible for determining whether a particular treatment is appropriate for you.

Each time you schedule an appointment, request an at-home or on-site visit, or otherwise request that Thirst IV Society or its affiliated Providers deliver services, you reaffirm your consent to be evaluated and treated under the terms of this Patient Consent and Financial Responsibility Guarantee.

By booking any service, you accept and agree to the following:

No Guarantees

You acknowledge that no specific outcome can be promised or guaranteed from IV therapy, vitamin therapy, wellness injections, telehealth consultations, or any other services offered through Thirst IV Society. While many clients may experience relief of symptoms or improved well-being, results vary significantly from person to person and depend on factors such as medical history, current health status, lifestyle, and adherence to recommendations.

You understand that any discussion of potential benefits is informational only and does not constitute a guarantee of results. You accept that choosing to proceed with treatment is based on your own assessment of potential benefits and risks, and not on any promise of a particular outcome.

Potential Risks

You understand that all medical and wellness treatments carry some degree of risk. The services offered by Thirst IV Society and its affiliated Providers may involve, without limitation:

• Insertion of IV catheters or needles into a vein or muscle
• Administration of fluids, vitamins, minerals, nutrients, and/or medications
• Physical assessment, vital sign monitoring, or medical screening
• Recommendations or referrals for additional treatment

Possible risks and side effects may include, but are not limited to:

• Pain, discomfort, bruising, bleeding, or swelling at the injection or IV site
• Vein irritation, inflammation (phlebitis), or infiltration
• Infection at the injection or IV site
• Allergic or hypersensitivity reactions, which may be mild, moderate, or severe
• Nausea, vomiting, headache, dizziness, or fainting
• Fluid overload or electrolyte imbalance
• Rare but serious complications, such as anaphylaxis, nerve injury, arrhythmia, or other adverse events

Before proceeding with any service, a Provider or trained team member will explain the nature of the treatment, discuss potential risks and benefits, and provide you with an opportunity to ask questions. By choosing to proceed, you acknowledge that you have had an opportunity to obtain all desired information, that your questions have been answered to your satisfaction, and that you voluntarily accept these risks.

Consent to Telehealth

You understand that some services may be delivered partly or entirely through telehealth, which can include audio, video, electronic messaging, or other digital means of communication. By agreeing to this Consent, you give your permission for Thirst IV Society and its affiliated Providers to evaluate, counsel, and, if appropriate, provide or recommend treatment to you via telehealth when such services are made available.

You understand that:

• Telehealth may involve real-time (synchronous) video or audio visits as well as store-and-forward (asynchronous) review of information, forms, photos, or test results.
• The Provider may rely on the information you submit electronically, including answers to intake questions, photos, health history, and descriptions of your symptoms.
• Telehealth is subject to certain limitations, such as the inability to perform a full physical examination or obtain certain vital signs or diagnostic data.

You acknowledge that telehealth services may not be appropriate for every condition and that a Provider may determine that you need an in-person visit, urgent care, or emergency services instead of or in addition to telehealth.

COVID-19 Risks and Other Infectious Disease Risks

You understand and accept that receiving in-person services, whether at your home, workplace, event venue, or other on-site location, may increase your risk of exposure to COVID-19 and other communicable diseases. Even with appropriate precautions, no environment can be guaranteed completely risk-free.

By requesting an in-person or mobile service, you confirm that:

• To the best of your knowledge, you are not currently experiencing symptoms consistent with COVID-19 or other serious contagious illnesses, or you have disclosed such symptoms to the Provider.
• You will immediately notify Thirst IV Society or the attending Provider if you develop symptoms of fever, cough, shortness of breath, loss of taste or smell, or other concerning signs of infection.
• You are aware that inviting Providers into your home, office, or event may present exposure risks not only to you, but also to other individuals in those locations.

You assume these risks and agree that Thirst IV Society and its Providers cannot guarantee that infection will not occur.

Complete Medical History

You understand that accurate assessment and safe treatment depend on complete and truthful disclosure of your medical history and current health status. This includes, without limitation:

• All prescription medications
• Over-the-counter drugs
• Vitamins, herbal products, and supplements
• Past and current medical conditions
• History of surgery or hospitalizations
• Allergies to foods, medications, or substances
• Use of alcohol, nicotine, or recreational substances
• Any recent illnesses, infections, or changes in health

You agree to provide thorough and up-to-date information and to promptly inform Thirst IV Society or your Provider of any changes in your health status, medications, or allergies. You understand that failure to disclose relevant information may increase the risk of adverse reactions or reduce the likelihood of beneficial results.

You acknowledge and agree that Thirst IV Society and its Providers will not be responsible for any harm or injury that arises, in whole or in part, from your failure to provide accurate and complete health information or your failure to follow recommendations provided to you.

Notice to All Female Clients Capable of Conceiving and Breastfeeding

Some therapies provided by Thirst IV Society or its affiliated Providers may not be appropriate during pregnancy or while breastfeeding. Certain ingredients, medications, or procedures may pose risks to a developing fetus or nursing infant.

If you are pregnant, suspect that you may be pregnant, are actively trying to conceive, or are breastfeeding, you agree to:

• Disclose this information prior to receiving any treatment
• Ask questions about potential risks and available alternatives
• Follow your Provider’s recommendations, which may include deferring or modifying treatments

By signing this Consent, you confirm that you will inform your Provider immediately if your pregnancy or breastfeeding status changes. You recognize that failure to do so could put you or your child at risk and may limit the Provider’s ability to deliver safe care.

Acknowledgement of Privacy Practices

You understand that your health information is protected by applicable privacy and confidentiality laws. Thirst IV Society, and any affiliated medical practices or Providers, maintain privacy practices that govern how your information may be collected, used, and disclosed for treatment, payment, and healthcare operations.

By agreeing to this Consent, you acknowledge that:

• You have been informed that privacy practices are available for your review upon request or via posted notices or electronic documents.
• You may ask questions at any time about how your information is handled.
• Your information may be shared with Providers, pharmacies, laboratories, or other entities as reasonably necessary to coordinate your care and process payment, consistent with applicable law.

Laboratory Products and Services

Certain services offered by or through Thirst IV Society may require laboratory testing or diagnostic services, which could include, for example:

• At-home sample collection kits
• Blood draws or other specimen collection
• Testing performed by external laboratories or diagnostic facilities

You understand and agree that:

• Laboratory tests may be provided by third-party laboratories that are independent from Thirst IV Society.
• No laboratory test is perfect, and results may occasionally be inaccurate or inconclusive. This may include false-positive, false-negative, or indeterminate results.
• Test results may influence your Provider’s clinical decisions, but those results are only one factor among many, including your symptoms, history, and physical findings.

You acknowledge that neither Thirst IV Society nor its Providers guarantee the accuracy or reliability of any laboratory or diagnostic testing and that such testing may affect diagnosis and treatment options. You understand that you may be advised to obtain additional testing, seek in-person examination, or follow up with your primary care provider or specialist based on those results.

Consent to Telehealth Services

The purpose of this section is to provide you with additional information about telehealth services that may be delivered by or through Thirst IV Society. Telehealth, for purposes of this Consent, includes the use of secure digital technologies for communication, evaluation, counseling, management, and monitoring of your health when the Provider and patient are not in the same physical location.

For example, telehealth may include:

• Real-time, interactive audio and/or video visits
• Secure messaging or chat
• Submission of photos, forms, or health questionnaires
• Remote review of your information by a Provider
• Automated or digital tools that support clinical decision-making or patient education

Telehealth may be used for many purposes, including evaluation of symptoms, follow-up care, treatment planning, wellness counseling, and review of test results. However, telehealth has inherent limitations and may not be appropriate for all conditions. You understand that the choice to use telehealth is made jointly by you and your Provider, subject to legal and clinical constraints.

Possible Benefits of Telemedicine

You understand that there are potential benefits to receiving certain services through telehealth, including, but not limited to:

• Improved convenience and access:
  Telehealth may allow you to connect with a Provider from your home, workplace, hotel, or other location, reducing travel time and the need to visit a clinic or office.
• Flexible scheduling:
  Virtual visits may be easier to schedule around your daily obligations, making it more practical to receive advice or follow-up care.
• Continuity of care:
  Telehealth can facilitate ongoing communication with Providers, help monitor your response to treatments, and enable quicker modifications to your plan of care when needed.
• Faster clinical decision-making:
  In some cases, telehealth may allow Providers to review your symptoms, history, or lab results more quickly and determine whether in-person care, urgent care, or emergency services are necessary.
• Enhanced comfort and privacy:
  Some clients feel more comfortable discussing sensitive health issues from their own environment rather than in a clinic setting.

You acknowledge that while these benefits are possible, they are not guaranteed, and telehealth may not always be available or appropriate for your particular situation.

Possible Risks of Telemedicine

You also understand that telehealth is associated with certain risks and limitations, including, but not limited to:

• Limited physical examination:
  Because the Provider cannot physically examine you in person, certain signs and findings may be missed or difficult to assess. Poor image quality, suboptimal lighting, or limitations in audio or video may make it harder for the Provider to evaluate your condition thoroughly.
• Incomplete clinical information:
  The Provider may rely on the information you provide electronically. If you omit, forget, or misunderstand important details, this could affect clinical decision-making. Lack of access to your complete medical records may increase the risk of medication interactions, allergic reactions, or diagnostic error.
• Technical failures:
  Telecommunications systems may experience interruptions, delays, or failures, which may affect your ability to communicate effectively with the Provider. This could lead to delays in evaluation or treatment, incomplete visits, or the need to reschedule.
• Limitations on treatment options:
  Certain conditions cannot safely or legally be treated via telehealth alone. For example, some medications, procedures, or interventions may require an in-person physical examination, diagnostic testing, or more extensive evaluation. A Provider may determine, in their sole professional judgment, that you require in-person care or emergency services instead of continued telehealth.
• Privacy and security risks:
  Although Thirst IV Society and affiliated Providers use commercially reasonable safeguards designed to protect your privacy and the security of your information, no system is completely secure. You understand that:
  • Electronic communications may be intercepted, accessed, or disclosed by unauthorized persons despite security measures.
  • Using shared devices, public Wi-Fi, or non-secure networks could increase your risk.
  • You are responsible for taking steps to protect your own devices and surroundings (for example, using headphones or ensuring privacy during a telehealth session).

By choosing to use telehealth services, you acknowledge and accept these risks and agree that you understand the limits of telehealth in comparison to a traditional in-person visit.

You further agree and understand that:

1. Telehealth services are not a substitute for all forms of in-person medical care.
2. A Provider may determine that your condition is not suitable for telehealth and may recommend that you seek in-person evaluation, urgent care, or emergency services.
3. It is your responsibility to seek immediate in-person or emergency care if you experience severe, new, or worsening symptoms, such as chest pain, difficulty breathing, sudden weakness, severe bleeding, or other alarming signs.

You understand that you are free to decline or discontinue telehealth services at any time and that you may ask questions or request clarification about any aspect of telehealth before or during your visit.

If you have any questions about this Patient Consent to Treat and Financial Responsibility Guarantee, about telehealth services, or about how your information is used, you may contact Thirst IV Society using the contact information provided on our website or booking platform.

BY CLICKING “AGREE,” YOU CONFIRM THAT YOU HAVE READ THIS ENTIRE DOCUMENT, THAT YOU UNDERSTAND ITS CONTENTS, THAT YOU HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS, AND THAT YOU VOLUNTARILY ACCEPT ALL TERMS, CONDITIONS, AND RESPONSIBILITIES DESCRIBED ABOVE WITH RESPECT TO YOUR CARE WITH THIRST IV SOCIETY.